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	<title>M0服务对象临床观察表</title>
	
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	患者：<span id="spAnswerUser">&nbsp;</span><br/>
	记录时间：<span id="spAnswerDate">&nbsp;</span>
	</div>
	
	<div id="div_q">
		<h4>I.术前检查结果</h4>
		I1.血压： <div id="question_189" name="question_189" title="189" type="3" style="display:inline"></div>/<div id="question_190" name="question_190" title="190" type="3" style="display:inline"></div> mmHg<br/>
		I2.血红蛋白：<div id="question_191" name="question_191" title="191" type="3" style="display:inline"></div> 克/升<br/>
		I3.妇科检查<br>
		
		<div style="margin-left: 20px;">
		1)外阴
		<div id="question_192" name="question_192" title="192" type="1" style="display:inline">
			<div id="question_192_520" style="display: none;">未查</div>
			<div id="question_192_518" style="display: none;">正常</div>
			<div id="question_192_519" style="display: none;">异常</div>
		</div>
		<div id="question_193" name="question_193" title="193" type="3" style="display:inline"></div>
		<br/>
		2)阴道
		<div id="question_194" name="question_194" title="194" type="1" style="display:inline">
			<div id="question_194_523" style="display: none;">未查</div>
			<div id="question_194_521" style="display: none;">正常</div>
			<div id="question_194_522" style="display: none;">异常</div>
		</div>
		<div id="question_195" name="question_195" title="195" type="3" style="display:inline"></div>
		<br/>
		3)宫颈
		<div id="question_196" name="question_196" title="196" type="1" style="display:inline">
			<div id="question_196_526" style="display: none;">未查</div>
			<div id="question_196_524" style="display: none;">正常</div>
			<div id="question_196_525" style="display: none;">异常</div>
		</div>
		<div id="question_197" name="question_197" title="197" type="3" style="display:inline"></div>
		<br/>
		4)子宫
		<div id="question_198" name="question_198" title="198" type="1" style="display:inline">
			<div id="question_198_529" style="display: none;">未查</div>
			<div id="question_198_527" style="display: none;">正常</div>
			<div id="question_198_528" style="display: none;">异常</div>
		</div>
		<div id="question_199" name="question_199" title="199" type="3" style="display:inline"></div>
		<br/>
		5)附件
		<div id="question_200" name="question_200" title="200" type="1" style="display:inline">
			<div id="question_200_532" style="display: none;">未查</div>
			<div id="question_200_530" style="display: none;">正常</div>
			<div id="question_200_531" style="display: none;">异常</div>
		</div>
		<div id="question_201" name="question_201" title="201" type="3" style="display:inline"></div>
		<br/>
		6)阴道分泌物
		<div id="question_202" name="question_202" title="202" type="1" style="display:inline">
			<div id="question_202_535" style="display: none;">未查</div>
			<div id="question_202_533" style="display: none;">正常</div>
			<div id="question_202_534" style="display: none;">异常</div>
		</div>
		<div id="question_203" name="question_203" title="203" type="3" style="display:inline"></div>
		</div>
		
		<h4>J.手术情况</h4>
		<strong>术前情况</strong><br/>
		<div class="comBox">
			J1.术前宫腔深度：<div id="question_204" name="question_204" title="204" type="3" style="display:inline"></div>cm<br/>
			J2.麻醉情况：
			<div id="question_205" name="question_205" title="205" type="1" style="display:inline">
				<div id="question_205_536" style="display: none;">无</div>
				<div id="question_205_537" style="display: none;">静脉麻醉</div>
				<div id="question_205_538" style="display: none;">麻醉性镇痛药</div>
			</div>
			<div id="question_206" name="question_206" title="206" type="3" style="display:inline"></div>
		</div>
		<strong>吸引情况</strong><br/>
		<div class="comBox">
		J3.使用 <div id="question_207" name="question_207" title="207" type="3" style="display:inline"></div> 号吸管<br/>
		J4.负压 <div id="question_208" name="question_208" title="208" type="3" style="display:inline"></div> mmH2O<br/>
		J5.吸引 <div id="question_209" name="question_209" title="209" type="3" style="display:inline"></div> 次<br/>
		J6.吸出物：
		<div id="question_210" name="question_210" title="210" type="1" style="display:inline">
			<div id="question_210_539" style="display: none;">完整胚囊</div>
			<div id="question_210_540" style="display: none;">破碎胎囊</div>
			<div id="question_210_541" style="display: none;">其他</div>
		</div>
		<div id="question_211" name="question_211" title="211" type="3" style="display:inline"></div> <br/>
		J7.术中出血量：<div id="question_212" name="question_212" title="212" type="3" style="display:inline"></div> 毫升<br/>
		J8.术后宫腔深度：<div id="question_213" name="question_213" title="213" type="3" style="display:inline"></div> cm<br/>
		</div>
		
		<strong>药物流产情况</strong>
		<div class="comBox">
		J9.米非司酮总剂量：<div id="question_214" name="question_214" title="214" type="3" style="display:inline"></div> mg<br/>
		J10.首次服药日期：<div id="question_215" name="question_215" title="215" type="3" style="display:inline"></div> <br/>
		J11.前列腺素种类：<div id="question_216" name="question_216" title="216" type="3" style="display:inline"></div> <br/>
		J12.前列腺素总剂量： <div id="question_217" name="question_217" title="217" type="3" style="display:inline"></div> <br/>
		J13.服药日期：<div id="question_218" name="question_218" title="218" type="3" style="display:inline"></div> <br/>
		J14.留院观察期间胚囊是否排出：
		<div id="question_220" name="question_220" title="220" type="1" style="display:inline">
			<div id="question_220_542" style="display: none;">排出</div>
			<div id="question_220_543" style="display: none;">部分排出</div>
			<div id="question_220_544" style="display: none;">完全未排出</div>
		</div> <br/>
		J15.是否发生不完全流产：
		<div id="question_221" name="question_221" title="221" type="1" style="display:inline">
			<div id="question_221_545" style="display: none;">是</div>
			<div id="question_221_546" style="display: none;">否</div>
		</div><br/>
		J16.是否清宫：
		<div id="question_222" name="question_222" title="222" type="1" style="display:inline">
			<div id="question_222_549" style="display: none;">是，发生不完全流产</div>
			<div id="question_222_550" style="display: none;">是，本院药物流产后常规清宫</div>
			<div id="question_222_551" style="display: none;">否</div>
		</div> 
		</div>
		
		<h4>K.人工流产后即时放置IUD情况</h4>
		K1.放置节育器种类：<div id="question_223" name="question_223" title="223" type="3" style="display:inline"></div><br/>
		K2.放置是否顺利：
		<div id="question_224" name="question_224" title="224" type="1" style="display:inline">
			<div id="question_224_552" style="display: none;">顺利</div>
			<div id="question_224_553" style="display: none;">不顺利</div>
			<div id="question_224_554" style="display: none;">放置失败</div>
		</div>
		<div id="question_225" name="question_225" title="225" type="3" style="display:inline"></div>
		<div id="question_226" name="question_226" title="226" type="3" style="display:inline"></div><br/>
		K3.术中/术后用药：<div id="question_227" name="question_227" title="227" type="3" style="display:inline"></div><br/>
		K4.填表人：<div id="question_228" name="question_228" title="228" type="3" style="display:inline"></div>
		
		
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